title: [Differential diagnosis of and therapy for anaplastic astroblastoma: case report and review of the literature].
abstract: Astroblastomas are rare glial tumors. We report a case of 33-year-old woman with high-grade astroblastoma with hypervascularity. She had a one-month history of right visual disturbance and papillar edema. MRI revealed a lobulated mass with cysts and flow voids in the right superficial frontal lobe, a phenomenon described as "bubbly appearance". Right carotid angiography demonstrated marked tumor stain and early venous filling. MR spectroscopy showed an increase in myoinositol and the choline/creatine ratio, and decreased N-acetyl aspartate. The lipid and lactate level was not increased. The well-circumscribed tumor was totally resected. Histological examination showed perivascular pseudorosettes and hyalinization of blood vessels with high cellularity, anaplastic nuclear features, focal necrosis, mitosis, and endothelial proliferation. Immunohistochemically, glial fibrillary acidic protein and S-100 protein were intensely positive and the MIB-1 labeling index was high(20%)in the tumor cells. Based on these findings, a diagnosis of high-grade astroblastoma was made. The patient received postoperative radiotherapy and chemotherapy with temozolomide and suffered no relapse in the course of 3 years after surgery. Characteristically, astroblastomas manifest a "bubbly appearance" and a lobulated mass on MRI scans. As these tumors tend to be hypervascular, angiograms are useful for designing the operative strategy. However, their low-or high grade is difficult to ascertain preoperatively based on MRI-, MRS-, and DSA findings. The standard therapy for high-grade astroblastoma is total resection and postoperative radiation therapy. As the incidence of tumor recurrence is high, we recommend additional chemotherapy with TMZ.
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, The University of Tokushima.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kurashiki
authors.forename: Teruyoshi
authors.initials: T
authors.lastname: Kageji
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Mizobuchi
authors.forename: Junichiro
authors.initials: J
authors.lastname: Satomi
authors.forename: Koichi
authors.initials: K
authors.lastname: Satoh
authors.forename: Takanori
authors.initials: T
authors.lastname: Hirose
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagahiro
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D059248:Chemoradiotherapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D018302:Neoplasms, Neuroepithelial / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome